Microblading Precautions

PLEASE READ CAREFULLY AND SIGN BELOW:

Microblading procedure normally requires multiple treatment sessions. For best results, clients will be required to return for at least one re-touch appointment. This will take place between 4-6 weeks after the initial procedure.Please be aware that color intensity will be significantly darker and sharper immediately after the procedure. This will reduce by 30%-50%Although numbing cream is used during the procedure, slight sensitivity/ discomfort may still be felt by sensitive clients.Delicate or sensitive skin may be red and/ or swollen after the procedure.Please wear your normal make-up to the salon on the day of your procedure.Please do not drink alcohol the night before treatment.Where possible, try to avoid the following herbs and spices prior to your appointment:Black pepper (Piper nigrum), Cardamom (Elettaria cardamomum), any member of theZingiberaceae (Ginger) family Cayenne (Capsicum frutescens) Cinnamon (Cinnamomum cassia),Garlic (Allium sativum), Horseradish (Armoracia lapathifolia), Mustard - A patch test will beperformed, unless waived upon request.Any brow shaping using waxing should be performed at least 48hrs before the treatment.Electrolysis treatment should be undergone no less that 5 days before the treatment.AHA preparations should be undergone no less than 2 weeks before the treatment.Chemical, laser peel or Retin-A should not be utilized 6 weeks before the procedure.

Allergic Reactions & Numbness:

Allergic reaction: can occur from any anesthetics using during procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other symptoms associatedwith an allergic reaction.

Numbness: We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to skin type. Some clients report the area to be completely numb, while others may experience some discomfort.

Procedure: For microblading procedure a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy/chemist. The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to treatment. As a result of the treatment, combined with the use of the anesthetic you can expect to experience some redness/ swelling that can last 1 - 4 days. You should always follow your post procedure advice/ after care for the best results.

I have read and fully understood the above information provided and any risks involved with the use of topical anesthetic and I therefore consent to the use of the anesthetic for the microblading procedure. I agree to follow pre-procedure advice closely.​​

Signature *

Health Questionnaire

Are you pregnant? *

YesNoI'm a guy, of course not!

Are you breastfeeding? *

YesNoAgain, I'm a guy!

Have you received a severe sunburn in the last 72 hours? *

YesNo

Have you received botox within the last 2 weeks? *

YesNoI get botox, but haven't in over 2 weeks

Do you have difficulty healing? *

YesNo

Do you scar easily? *

YesNo

Liability Consent

Procedure To Be Performed *

I specifically acknowledged that I have been advised of the matters set forth below and agree as follows:Please input your Initials at each line:

I acknowledge that obtaining permanent make up is my choice alone and the application of permanent make up will result in a permanent change to my appearance and that needles and ink will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in permanent make up to the original condition and it is very costly to remove. *

I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I do not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia or any other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood. *

If I suffer from hepatitis, or other risk factors for blood-born pathogen exposure, or any other communicable disease, I have informed the technician of the fact and have been advised of any medications and procedure necessary to promote the satisfactory healing of my tattoo. *

I do not suffer from any medical or skin conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the permanent make up, or any open wounds or lesions at the site of the tattoo. *

I do not have a history of medication use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. *

I have advised the technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the technician to determine whether I might have an allergic reaction to the permanent make up process and further acknowledge that such reaction is possible. *

I have truthfully represented to the technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo at this time. *

I acknowledge that infection is always possible as a result of permanent makeup applications, and I agree to follow all suggested instructions concerning the care of the permanent make-up site while it is healing *

I acknowledge and give consent to this permanent make-up studio to use images of my tattoo(s) for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and or television etc. *

I understand I will have permanent make-up applied using appropriate instruments and sterilization techniques. I understand that the permanent make-up site usually takes 2 weeks or longer to heal. I agree to release and forever discharge, and hold harmless, the technician, all employees, contractors, and the management of the permanent make-up studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way to my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure. *

I am aware that that tattoos, ink, dyes, and pigments have not been approved by the federal Food and Drug administration and that the health consequences of using these products are unknown. *

All information gathered from the client that is personal medical information and that is subject to the Federal Health Insurance Portablity and Accountability Act of 1996 (HIPAA) or similar state laws shall be maintained or disposed of in compliance with those provisions *

Brow Questionnaire

We've got a few questions for you to ensure you are the right candidate! Please upload clear photos of your eyebrows in in-direct sunlight (stand in front of a window). Straight on, and each brow at a 45 degree angle. Here are some examples:

Please upload a front photo *

Max file size: 20MB

Please upload a side photo *

Max file size: 20MB

Please upload the other side *

Max file size: 20MB

What is you biggest concern with your eyebrows *

What would you like to see improved in regards to shape, thickness, color, length? *

Please upload a photo of when you liked you brows the best *

Max file size: 20MB

Please upload a photo of someone's brows you would like yout brows to look like *

Max file size: 20MB

Microblading Disclaimer

Please read the following statements carefully:

Microblading is a way of cosmetic tattooing. Re-touch procedures may be required. A healing period of 4 weeks is required before a touch up procedure can be performed. On a rare occasion, the pigment may migrate under the skin. Procedure of microblading may be slightly uncomfortable. The pigments will fade. Immediately after the procedure, the pigment can appear 30-50% darker than the desired result. Although extremely rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be applied to pregnant women or nursing mothers. Permanent cosmetics cannot be applied to any person under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after microblading procedure, you should notify/ discuss with your doctor. Possible scaring may occur, but is extremely rare.

​Initial that you read and understand the above statement *

Initials *

Scheduling Policies

We require 72 hours notice for canceling appointments. We ask this so we may open up your time-slot to another microblading client. Cancellations made less than 72 hours may result in a charge of the scheduled appointment. No-show appointments will be charged the full amount of the treatment scheduled. Your scheduled appointment is booked for you and only you, our Artists cannot fill no-show appointments, so we ask our clients to have consideration for their Artist. When scheduling your appointment, we require a credit card number to hold your appointment, along with a deposit of $200.

Initials *

Required Confirmations

Appointments MUST be confirmed, and we've made it SUPER easy to do so! Each client receives a confirmation email 72 hour before their scheduled visit. This email has a big green button to click that says "confirm". Texts are also sent if you are signed up for them, simply reply "YES". If these go unconfirmed, we will call you for a confirmation day before.

Initials *

Consent Form Confirmation

I have completed this form to the best of my knowledge and agree the information I have provided is true and accurate. BROWHOUSE is not responsible for any side effects caused by inaccurate information I have disclosed on this form. I understand that while every precaution is taken, adverse reactions are a possibility when microblading; including skin irritation, lifting etc. I understand that any contraindication boxes I checked on this form can increase my chances of adverse reactions to microblading services. I understand that all health history information I have provided is confidential and cannot be shared with anyone other than BROWHOUSE and their employees. I give BROWHOUSE and their Microblading Artists permission to perform services I request.